Medicare Part D Prescription Drug Coverage.
A Medicare Part D (Rx Plan) through a private insurance company can help you drastically reduce out-of-pocket expenses at the pharmacy. Each insurance company offering prescription drug plans is mandated by Medicare to cover certain Rx’s pharmacies with the network.
One of the most common questions we hear is, “I don’t take any prescriptions. Why do I need to purchase a Part D plan?” The answer is simple: If you don’t enroll while eligible for Part D and don’t hold credible Part D coverage, Medicare will charge a 1% late enrollment penalty each month until you do enroll. This would be applied to the future plan chosen and would be applicable to the average monthly premium for that year. Monthly premiums can also vary based on household income.
Medicare Part D Rx Plan coverage and costs vary by the company providing the coverage. Each company has a formulary of covered drugs that are listed into different “tiers.” The level tier of the drug will determine the cost; the lower the tier of the drug, the lower the cost.
Initial Coverage Phase
During this phase, cost sharing is typically 25% of your total drug cost until you reach a spending limit of $2,850. (This is the cost you and your plan have paid combined). Your drug plan covers the other 75%.
Commonly referred to as the donut hole. When your total drug costs exceed $2,960 (2015), your cost sharing will increase to 45% for covered brand named drugs and 65% of covered generics.
Catastrophic coverage begins when you reach the out-of-pocket threshold ($4,700 in 2015). The out-of-pocket threshold is the sum of the deductible, the 25% coinsurance during the Initial Coverage period, and your drug costs plus the manufacturer’s discounts during the coverage gap. Your cost-sharing is the greatest of 5% of the covered drug cost or $2.55 for covered generics or $6.35 for covered brands. Your plan will pick up the remainder of your covered drug costs during this phase.
Ready to Talk to an Advisor?
At Senior HealthCare Solutions, we take the time to assess your situation and review all plans to see which will be the best fit for you. To compare Medicare Part D Plans (Rx) and find the best Part D (Rx) Plans in your area, call us today by dialing 1-866-MEDIGAP (633-4427) or complete our Contact Form and one of our licensed advisers will be in touch.